Gastro-Oesophageal Reflux and Chronic Fatigue in Children and Adolescents

Chronic fatigue syndrome (CFS) (post-viral or post-infective fatigue syndrome or myalgic encephalomyelitis) is common in adults and occurs in older children and adolescents. Abdominal pain is reported to be a common feature. Despite intensive research the aetiology remains unknown.

Over 36 months we saw in total 19 children and adolescents with symptoms of CFS or idiopathic chronic fatigue. Ages at presentation ranged from 7 to 16.75 years. The male to female ratio was 8:11. The duration of the symptoms at diagnosis varied from 3 months to 4 years. 15 of the 19 patients (79%) had upper gastro-intestinal symptoms. Three of these 15 patients declined further investigations and/or were lost to follow-up. Gastro-oesophageal reflux was found in all of the remaining 12; pH probe demonstrated significant reflux over 24 hours in each.

Endoscopy of the upper gastro-intestinal tract was performed in 7 and showed evidence of reflux oesophagitis in 6. In addition lactase deficiency was diagnosed in one of these patients. We treated these children with standard reflux treatment and low lactase diet for the lactase deficient child. Among the 11 with an adequate period of follow-up symptoms of chronic fatigue resolved with improvement of the reflux in 7 children (64%) and remained unchanged in four (36%).

Conclusion
Gastro-oesophageal reflux may cause symptoms of chronic fatigue in children and adolescents and should be considered in the differential diagnosis of chronic fatigue syndrome. Night time reflux may interfere with a normal sleep pattern, causing symptoms of chronic fatigue. Alternatively, the disease process responsible for chronic fatigue may also interfere with the function of the lower oesophageal sphincter. Since abdominal pain is a recognised feature of CFS, the associated gastrointestinal disease in our patients would have been unrecognised in most cases without definitive investigations. Treatment of reflux (and lactase deficiency) was associated with resolution of chronic fatigue symptoms in more than half of the investigated children and adolescents. A controlled, prospective study appears to be warranted.